Could Talk Therapy Ease Your Pain During Surgery?

An excerpt from the new book 'Cure: A Journey Into the Science of Mind Over Body.'

By
Jo Marchant

Feb 8, 2016

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Millions of people every year undergo invasive procedures such as biopsies and keyhole surgery while wide awake. Unlike open surgery, which involves cutting a large incision in the skin, in a keyhole operation the surgeon works through a tiny opening, guided by images from a camera on the end of a tube.

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Wounds heal faster than with open surgery and patients can often go home the same day. Patients don't generally require general anesthesia, and instead receive local anesthetics combined with sedative drugs. But despite the benefits, being awake while you're operated on can be a daunting prospect. Dangerous side effects limit the amount of sedative drugs that doctors can give safely, and patients typically report high levels of anxiety and pain.

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One of the people who carries out such procedures is intervention radiologist Elvira Lang. "I do surgery on awake people," she says. "You have the challenge to get a patient on the table, keep them on the table, and be able to do what you need to do with dignity." Instead of simply dishing out drugs, she wondered if she could mobilize her patients' psychological resources. So she developed a blend of empathic communication skills, positive suggestion and visual imagery that she hoped would help them to relax, and ease their pain. She calls it Comfort Talk.

While working at Harvard Medical School hospitals in Boston, Massachusetts, Lang tested her approach in randomized controlled trials of more than 700 patients undergoing invasive medical procedures such as breast biopsies or removing a kidney tumor. In the trials she compared her intervention plus standard care ("conscious sedation," where intravenous pain-relieving drugs are available on demand), with standard care alone.

In all of Lang's trials, the patients who received Comfort Talk reported far less pain and anxiety than those who received standard care alone.

In all of Lang's trials, the patients who received Comfort Talk reported far less pain and anxiety than those who received standard care alone. In a trial of 241 people undergoing renal and vascular procedures, pain scores in the intervention group peaked at 2.5 out of 10 compared to 7.5 for the controls, and their anxiety, instead of steadily rising, dropped to zero.

That's not all, however. Lang found that prioritizing patients' psychological state confers hard physical benefits too. Those who received Comfort Talk required much lower levels of sedative drugs, and suffered far fewer complications. In the trial of renal and vascular surgery, for example, patients in the intervention group required only half the amount of drugs. Their procedures were also completed on average 17 minutes faster, saving the hospitals $338 per patient.

But after two decades of work, and the kind of trial results that drug companies would kill for, Lang's ideas were not being taken up by other hospitals. So she decided to disseminate the technique herself and left Harvard to set up her own company, training medical teams in her approach. She's still running clinical trials but now focuses on economic rather than health outcomes "because frankly that's what hospital administrators are interested in."

One area she hopes to transform is MRI scans. If patients are too nervous to lie still in the scanner for the hour or so of their exam, the scan has to be aborted—contributing to what is known as the "claustro rate." Reducing the claustro rate is a continual struggle, says Kelly Bergeron, manager of the MRI facility at Boston Medical Center. MRI scans can be particularly daunting for patients like those at BMC, she explains, because they tend to be poorly educated and aren't well versed in medicine. "They don't really know what's happening to them. So to bring them into this sort of technology is frightening."

If patients fail to complete their scan the first time around, they have to come back for a second appointment, generally with the help of a sedative, says Bergeron. But if they are very anxious the drug may not work. "They fight the medication. What might knock somebody out for a week, this patient is bouncing off the walls." So they have to come back a third time, perhaps under general anesthesia, with all the health risks, recovery time, and cost that entails. Lang estimates that such wasted scans cost between $425 million and $1.4 billion each year in the U.S. If Comfort Talk helps people having biopsies and keyhole surgery, could it get them through an MRI too?

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